The new tool to measure frailty in the elderly recently promoted by Kenneth Rockwood and colleagues1 is one of many produced in what appears to be a never-ending search for a Holy Grail: a precise and useful measure of frailty in the geriatric population.
The care of geriatric patients is difficult and complex. It involves managing chronic disease, accommodating for cognitive and functional decline and collaborating with families and other informal caregivers, the goal being a reasonable preservation of an individual's independence balanced against their care and safety needs. Teams of health care workers must recognize the unique features of each case and bring flexibility and a degree of realistic optimism to the job.
A potential danger in the use of tools (such as the Canadian Study of Health and Aging Clinical Frailty Scale) is that a patient might be assigned to a category from which he or she cannot escape: although the health of an elderly person can improve, it is potentially time-consuming and inconvenient for a health care system to reassess him or her. There is a significant risk that expediency might override fairness.
Perhaps efforts would be best focused on developing collaborative and effective health care delivery systems for elderly people in need that accentuate realistic optimism and flexibility. This might be of more use than the ongoing efforts to define a condition that in most instances is self-evident.
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